Dry eye syndrome ( DES ), also known as keratoconjunctivitis sicca ( KCS ), is a dry eye condition. Other related symptoms include irritation, redness, discharge, and tired eyes. Blurred vision can also occur. The symptoms can range from mild and occasionally to severe and continuous. Corneal scarring can occur in some cases without treatment.
Dry eyes occur when the eyes do not produce enough tears or when the tears evaporate too quickly. This can occur due to the use of contact lenses, meibomian gland dysfunction, allergies, pregnancy, SjÃÆ'¶gren syndrome, vitamin A deficiency, LASIK surgery, and certain medications such as antihistamines, some blood pressure medications, hormone replacement therapy, and antidepressants. Chronic conjunctivitis such as from exposure to tobacco smoke or infections may also cause conditions. Diagnosis is largely based on symptoms even though a number of other tests may be used.
Treatment depends on the underlying cause. Artificial tears are the usual first-line treatment. Wrap around the appropriate glasses close to the face can reduce the evaporation of tears. Stopping or changing certain medications may help. Ciclosporin drugs or steroid eye drops may be used in some cases. Another option is a lacrimal blockage that prevents tears from flowing from the eye's surface. Dry eye syndrome occasionally makes wearing contact lenses impossible.
Dry eye syndrome is a common eye disease. It affects 5-34% of people to some extent depending on the population being observed. Among the older people it affects up to 70%. In China it affects about 17% of people. The phrase "keratoconjunctivitis sicca" means "corneal and conjunctival drought" in Latin.
Video Dry eye syndrome
Signs and symptoms
The typical symptoms of dry eye syndrome are drought, burning and sandy eye irritation that is getting worse as the day passes. Symptoms can also be described as itchy, itchy, stinging or tired. Other symptoms are pain, redness, exciting sensation, and pressure behind the eyes. There may be a feeling that something, like a speck of dirt, is in the eye. The damage produced on the surface of the eye increases the discomfort and sensitivity to bright light. Both eyes are usually affected.
There may also be dirt coming out of the eye. Although it may seem strange, dry eyes can cause the eyes to become watery. This can happen because the eyes are irritated. A person may experience an excessive tear in the same way as another person if something enters the eye. These reflex tears do not always make the eyes feel better. This is because they are the watery type produced in response to injury, irritation, or emotion. They do not have the necessary lubricant qualities to prevent dry eyes.
Because it blinks with teary eyes, symptoms are exacerbated by activity where the blink rate is reduced due to prolonged use of the eye. These activities include prolonged reading, computer use, driving, or watching television. Symptoms increase in windy, dusty or smoky areas (including cigarette smoke), in dry environments in the highlands including airplanes, in days with low humidity, and in areas where air conditioning (especially in cars), fans, heating , or even a hairdryer is in use. Symptoms are reduced during cold, rainy, or foggy weather and in humid places, such as in the bathroom.
Most people who have dry eyes have mild irritation without long-term effects. However, if this condition is not treated or becomes severe, it can cause complications that can cause eye damage, resulting in vision impairment or (rarely) vision loss.
Symptom examination is a key component of the diagnosis of dry eye - to the extent that many believe dry eye syndrome becomes a symptom-based illness. Several questionnaires have been developed to determine the scores that allow the diagnosis of dry eye. The McMonnies & amp; Dry eye questionnaires are often used in clinical studies of dry eye.
Maps Dry eye syndrome
Cause
Abnormalities of one of three layers of tears produce unstable tear film, which causes dry eye symptoms.
Teardown or excessive evaporation
Keratoconjunctivitis sicca is usually caused by inadequate tear production from lacrimal hyposecretion or excessive tear evaporation. The aqueous water layer is affected, resulting in a dilute tear deficiency (ATD). The lacrimal glands do not produce enough tears to keep the entire conjunctiva and cornea covered by a complete layer. This usually happens to healthy people. Growing age is associated with a decrease in tears. This is the most common type found in postmenopausal women.
Causes include idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation. In rare cases, it may be a symptom of collagen collagen disease, including relapse of polychondritis, rheumatoid arthritis, granulomatosis with polyangiitis, and systemic lupus erythematosus. SjÃÆ'¶gren's syndrome and other autoimmune diseases are associated with aqueous tear deficiency. Drugs such as isotretinoin, sedatives, diuretics, tricyclic antidepressants, antihypertensives, oral contraceptives, antihistamines, nasal decongestants, beta-blockers, phenothiazines, atropine, and pain relievers such as morphine can cause or aggravate this condition. Infiltration of the lacrimal gland by sarcoidosis or tumor, or postradiation fibrosis of the lacrimal gland may also cause this condition. Recent attention has been paid to the composition of tears in normal or dry eye individuals. Only a small proportion of the 1543 protein is thought to cry neither differential nor regulated in dry eye, one of which is lacritin. Topical Lacritin promotes tearing in rabbit preclinical studies. Also, topical treatment of dry eye mouse eyes (Aire knockout mouse model dry eye) restores tears, and suppresses both corneal staining and inflammatory focal size in the lacrimal gland.
Additional causes
Aging is one of the most common causes of dry eyes because tear production declines with age. Some classes of drugs (both prescription and OTC) have been hypothesized as the main cause of dry eyes, especially in the elderly. In particular, anticholinergic drugs that also cause dry mouth are believed to improve dry eyes. Dry eyes can also be caused by thermal or chemical burns, or (in case of epidemics) by adenovirus. Numerous studies have found that diabetics are at an increased risk for disease.
About half of all people wearing contact lenses complain of dry eyes. There are two potential connections between the use of contact and dry eyes. Traditionally, it is believed that soft contact lenses, which float on a film of tears covering the cornea, absorb the tears in the eye. The relationship between loss in neural sensitivity and tear production is also the subject of current research.
Dry eyes also appear or worsen after LASIK and other refractive surgery, where the corneal nerve is cut off during the formation of the corneal flap. The corneal nerve stimulates the secretion of tears. Dry eyes caused by this procedure usually disappear after a few months, but can be permanent. People who think about refractive surgery should consider this.
Eye injuries or other problems with eyes or eyelids, such as protruding eyes or drooping eyelids can cause sicca keratoconjunctivitis. Eyelid disorders can damage the complicated flickering movements required to spread tears. Eye injuries or diseases that cause Boehm's Syndrome can be exacerbated by dry eyes.
Abnormal lipid tear lesions caused by blepharitis and rosacea, and mucinous tear densities caused by vitamin A deficiency, trachoma, diphtheria keratoconjunctivitis, mucocutaneous disorders and certain topical medications are the cause of sicca keratoconjunctivitis.
People with sicca keratoconjunctivitis have elevated levels of nerve growth factor tears (NGF). It is possible that the NGF of this ocular surface plays an important role in the inflammation of the eye surface associated with dry eye.
Pathophysiology
Having dry eyes for a while can cause small blisters on the surface of the eye. In advanced cases, the epithelium undergoes pathological changes, namely squamous metaplasia and loss of goblet cells. Some severe cases produce corneal surface thickening, corneal erosion, punctate keratopathy, epithelial defects, corneal ulcer (sterile and infected), corneal neovascularization, corneal scarring, corneal thinning, and even corneal perforation.
Other contributing factors may lack lacritin monomers. Lacritin monomer, the active form of lacritin, selectively decreases in water-deprived dry eyes, dry eye Sjogren's syndrome, dry eye-related contact lenses and on blepharitis.
Diagnosis
Dry eyes can usually be diagnosed with symptoms only. The test can determine the quantity and quality of tears. Examination of gap lights can be performed to diagnose dry eye and document damage to eyes.
The Schirmer test can measure the amount of humidity bathing the eyes. This test is useful to determine the severity of the condition. The five minute Schirmer test with and without anesthesia using Whatman # 41 filter paper with a width of 5 mm over 35 mm was performed. For this test, wetting under 5 mm with or without anesthesia is considered diagnostic for dry eyes.
If the results for the Schirmer test are not normal, a Schirmer II test can be performed to measure the reflex secretion. In this test, the nasal mucosa is irritated with a cotton-tipped applicator, after which tear production is measured by Whatman # 41 filter paper. For this test, wetting under 15 mm after five minutes is considered abnormal.
The tear-time test (TBUT) measures the time it takes to dilute the eye. The breakdown time of tears can be determined after placing a drop of fluorescein in the cul-de-sac.
A tear protein analysis test measures lysozyme contained in tears. In tears, lysozyme accounts for about 20 to 40 percent of the total protein content.
The lactoferin analysis test provides a good correlation with other tests.
The presence of the recently described Ap4A molecule, which naturally occurs in tears, is abnormally high in countries different from ocular drought. This molecule can be quantified biochemically by just taking a sample of tears with a regular Schirmer test. Utilizing this technique it is possible to determine the Ap4A concentration in a patient's tear and thus diagnose objectively if the sample shows dry eye.
The Tears Osmolarity Test has been proposed as a test for dry eye disease. Tear osmolarity may be a more sensitive method for diagnosing and assessing dry eye severity compared with corneal and conjunctival staining, tear break time, Schirmer test, and meibomian gland assessment. Others have recently questioned the usefulness of tear osmolarity in monitoring dry eye care.
Prevention
Avoiding refractive surgery (LASIK & PRK), limiting the use of contact lenses, limiting the use of computer screens, avoiding environmental conditions and not using certain antihistamines that can increase the prevalence of symptoms. Complications can be prevented by using wetting and drops and lubricating ointment.
Treatment
Various approaches can be taken for treatment. This can be summarized as: avoidance of exacerbation factors, stimulation and tear supplementation, increased tear retention, and eyelid removal and treatment of eye inflammation.
Dry eyes can be exacerbated by the smoky environment, dust and air conditioning and by our natural tendency to reduce our blink rates while concentrating. By deliberately flashing, especially during computer use and tired eye rest are the basic steps that can be taken to minimize discomfort. Rubbing the eyes of a person can irritate them further, so should be avoided. Conditions such as blepharitis can often coexist and pay special attention to cleansing morning and night eyelids with mild soap and warm compresses can improve both conditions.
Environmental control
Dry, windy environments and those with smoke and dust should be avoided. This includes avoiding hair dryers, heaters, air conditioners or fans, especially when the device is directed to the eye. Wearing goggles or directing the view down, for example, by lowering the computer screen can help protect the eyes when environmental factors incriminate can not be avoided. Using a humidifier, especially in winter, can help by adding moisture into the air in a dry room.
Rehydration
For mild and moderate cases, extra lubrication is the most important part of the treatment.
The application of artificial tears every few hours can provide temporary relief. Additional research is needed to determine whether certain artificial tear formulations are superior to others in treating dry eyes.
Autologous serum eye drops
None of the commercial-made tear-up preparations available include important tear components such as epidermal growth factors, hepatocyte growth factors, fibronectin, neurotrophic growth factors, and vitamin A - all of which have been shown to play an important role in healthy eye maintenance. surface epithelial environment. Autologous serum eye drops contain these essential factors. However, there is some controversy regarding the efficacy of this treatment. At least one study has shown that this modality is more effective than artificial tears in a randomized control study. A Cochrane 2017 review found mixed results when comparing autologous serum eye drops with artificial tears or saline. Evidence from the trials examined showed that autologous serum eye drops may have small short-term benefits when compared to artificial tears, but there was no evidence of improvement after 2 weeks. The systematic review concludes that further research is needed to understand the overall benefits of autologous serum serum drop treatment for people with dry eye symptoms.
Overall, investigators reported inconsistencies in possible US benefits for improving symptoms reported by participants and other objective clinical measures. There may be some symptom benefits with AS compared to artificial tears in the short term, but we found no evidence of effects after two weeks of treatment. A well-planned, large, high-quality RCT is warranted to examine participants with dry eye with different severity by using standardized questionnaires to measure the results reported by participants, as well as objective and objective clinical trials and biomarkers to assess the usefulness of US therapy for dryness. eye.
Additional options
The tear ointment can be used during the day, but is usually used at bedtime due to poor vision after application. They contain white petrolatum, mineral oil, and similar lubricants. They function as lubricants and emollients. The application requires pulling down the eyelid and applying a small amount (0.25 in) inside. Depending on the severity of the condition, it can be applied from every hour just at bedtime. It should not be used with contact lenses. Specially designed glasses that form moisture spaces around the eyes can be used to create additional moisture.
Drugs
Inflammation that occurs in response to tear film hypertonicity may be suppressed by mild topical steroids or with topical immunosuppressants such as ciclosporin (Restasis). Increased levels of NGF tears may be reduced by 0.1% prednisolone.
Diquafosol, a purinogenic receptor agonist P2Y2, is approved in Japan for managing dry eye disease by promoting tear secretion.
Lifitegrast is a new drug approved by the FDA for treatment of conditions by 2016.
Consumption of fish fatty acids and Omega-3
The consumption of dark meat fish containing omega-3 fatty acids diet is associated with a decreased incidence of dry eye syndrome in women. This finding is consistent with postulated biological mechanisms. The initial experimental work on omega-3 has shown promising results when used in topical applications or verbally given. A randomized, double-masked study published in 2013 to evaluate the effects of DHA (Omega-3, Brudy Sec 1.5) triglycerides, showed significant results compared to other methods currently in use.
Ciclosporin
Topical ciclosporin (topical ciclosporin A, tCSA) 0.05% eye drop emulsion is immunosuppressant. These drugs reduce surface inflammation. In an experiment involving 1,200 people, Restasis increased tear production in 15% of people, compared with 5% with placebo.
It should not be used when wearing contact lenses, during eye infections or in people with a history of herpes virus infection. Side effects include burning (general), redness, fluid, watery eyes, eye pain, foreign body sensations, itching, stinging, and blurred vision. Long-term use of ciclosporin at high doses is associated with an increased risk of cancer.
A cheaper generic alternative is available in some countries.
Saving tears
There are methods that allow natural and artificial tears to stay longer.
In each eye, there are two puncta - little holes that drain the tears to the tear ducts. There is a method to cover some or part of the tear ducts. This blocks the flow of tears into the nose, and thus more tears are available to the eye. Drainage to one or both puncta in each eye can be blocked.
Puncture needle inserted into puncta to block tear drainage. It is unclear whether plugs are timely effective in reducing the symptoms of dry eye syndrome. Timely plugs are considered "relatively safe", but their use may lead to epifora (watery eyes), and less frequently, serious infections and swelling of the teardrops where tears flow. They are reserved for people with moderate or severe dry eye when other medical treatments are inadequate.
If the punctal socket is effective, thermal or thermal cautery can be performed. In thermal cauterization, local anesthesia is used, and then a hot wire is applied. It shrinks the drainage area network and causes scar tissue, which closes the tear ducts.
More
The heating system that attempts to unblock the oil glands in the eye has some early evidence of benefits.
Surgery
In the case of severe dry eye, tarsorrhaphy can be performed in which the eyelids are partially united. This reduces palpebral fissures (eyelid separation), ideally leading to a reduction in tear evaporation.
Prognosis
Keratoconjunctivitis sicca is usually a chronic problem. The prognosis shows considerable variance, depending on the severity of the condition. Most people have mild to moderate cases, and can be treated symptomatically with lubricants. This provides considerable symptom relief.
When dry eye symptoms are severe, they can disrupt the quality of life. People sometimes feel their eyesight blur with use, or severe irritation to the point that they have trouble opening their eyes or they may not be able to work or drive.
Epidemiology
Keratoconjunctivitis sicca is relatively common in the United States, especially in older patients. In particular, the people most likely to get dry eye are those who are 40 years old or older. 10-20% of adults have Kericoconjunctivitis sicca. About 1 to 4 million adults (age 65-84) in the US are affected.
While people with autoimmune diseases have a high likelihood of having dry eyes, most people with dry eyes do not have an autoimmune disease. Examples of SjÃÆ'¶gren syndrome and associated sicca keratoconjunctivitis are present much more frequently in women, with a ratio of 9: 1. In addition, mild forms of sicca keratoconjunctivitis are also more common in women. This is partly due to hormonal changes, such as those that occur in pregnancy, menstruation, and menopause, can decrease tear production.
In areas of the world where nutritional deficiencies are common, vitamin A deficiency is a common cause. This is rare in the United States.
Racial predilection does not exist for this disease.
Synonyms
Other names for dry eyes include dry eye syndrome, sicca keratoconjunctivitis (KCS), dysfunctional tear syndrome, lacrimal keratoconjunctivitis, evaporating tear deficiency, aqueous tear deficiency, and LASIK-induced neurotrophic epitheliaopathy (LNE).
Other animals
Among other animals, keratoconjunctivitis sicca occurs in dogs, cats, and horses.
Dog
Keratoconjunctivitis sicca often occurs in dogs. Most cases are caused by genetic predisposition, but chronic conjunctivitis, canine distemper, and drugs such as sulfasalazine and trimethoprim-sulfonamide also cause disease. Symptoms include redness, yellow or greenish discharge, corneal ulceration, pigmented pigment, and corneal blood vessels. Diagnosis is made by measuring tear production with Schirmer's tear test. Less than 15 milliliters of tears produced in a minute is not normal.
Tear substitutes are a treatment mainstay, preferably containing methylcellulose or carboxymethyl cellulose. Ciclosporin stimulates tear production and acts as a suppressant to the immune mediation process that causes disease. Topical antibiotics and corticosteroids are sometimes used to treat secondary infections and inflammation. Surgery known as parotid channel transduction is used in some extreme cases where medical treatment does not help. This directs the channel from the parotid saliva glands to the eye. Saliva replaces tears. Dogs suffering from cherry eye should have a corrected condition to help prevent the disease.
Commonly affected breeds include:
- King Cavalier Charles Spaniel
- Bulldog
- Chinese Shar-Pei
- Lhasa Apso
- Shih Tzu
- West Highland White Terrier
- Pug
- Bloodhound
- Cocker Spaniel
- Peking
- Boston Terrier
- Schnauzer Miniature
- Samoyed
Cat
- Facts About Corneal Disease and Cornea National Eye Institute (NEI).
- Dry Eye Syndrome in NHS Options
- Am.J.Managed Care - Dry Eye Disease: Pathophysiology, Classification, and Diagnosis
- Dry Eye Syndrome in eMedicine
- Dry Eyes (Keratoconjunctivitis Sicca) from The Pet Health Library
- Nasolacrimal and Lacrimal Apparatus, Merck's Veterinary Manual
Source of the article : Wikipedia
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